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    <div id="content">
        <h1>
            Cirrhosis</h1>
        <h5 class="updated">
            Last updated: Wednesday, 24, November, 2010</h5>
        <table cellpadding="0" cellspacing="0" class="two-column-process">
            <thead>
                <tr>
                    <th>
                        Causes + Complications</th>
                    <th class="description">
                        Appropriate Tests</th>
                </tr>
            </thead>
            <tr class="odd">
                <td class="first">
                </td>
                <td class="second">
                    <p>
                        The diagnosis is suspected on the basis of clinical assessment and supported by 
                        pathology tests.</p>
                    <p>
                        Although liver biopsy provides the definitive pathological diagnosis, it is not 
                        always indicated or feasible.</p>
                    <p>
                        Liver function can be assessed by <b>albumin, bilirubin, PT.</b></p>
                    <p>
                        Ongoing inflammation, necrosis and cholestasis are assessed by <b>AST, ALT 
                        (AST/ALT ratio), GGT, ALP, LD, immunoglobulins G, A, M.</b></p>
                    <p>
                        Liver function tests may be normal in quiescent cirrhosis.</p>
                    <p>
                        The findings may be complicated by the coexistence of acute hepatitis and/or 
                        hepatic failure.</p>
                </td>
            </tr>
            <tr>
                <td class="first">
                    <b>Causes</b></td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        Chronic Alcoholism</p>
                </td>
                <td class="second">
                    See
                    <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=43&amp;Itemid=27" 
                        target="_blank">Alcoholism</a></td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=307&amp;Itemid=27" 
                            target="_blank">Hepatitis B virus infection</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=309&amp;Itemid=27" 
                            target="_blank">Hepatitis D virus infection</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        See
                        <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=308&amp;Itemid=27" 
                            target="_blank">Hepatitis C virus infection</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        Autoimmune hepatitis</p>
                </td>
                <td class="second">
                    <b>Smooth muscle antibodies, liver/kidney microsomal antibodies.</b> See
                    <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=305&amp;Itemid=27" 
                        target="_blank">Hepatitis</a> chronic</td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Metabolic, including</p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <ul>
                        <li><a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=276&amp;Itemid=27" 
                                target="_blank">Haemochromatosis</a></li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <ul>
                        <li><a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=171&amp;Itemid=27" 
                                target="_blank">Cystic fibrosis</a></li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <ul>
                        <li>Alpha-1-antitrypsin deficiency</li>
                    </ul>
                </td>
                <td class="second">
                    <b>Alpha-1-antitrypsin</b>, with phenotyping, genotyping.</td>
            </tr>
            <tr>
                <td class="first">
                    <ul>
                        <li><a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=595&amp;Itemid=27" 
                                target="_blank">Wilson’s disease</a></li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <ul>
                        <li><a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=244&amp;Itemid=27" 
                                target="_blank">Galactosaemia</a></li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <ul>
                        <li>Type IV glycogen storage disease</li>
                    </ul>
                </td>
                <td class="second">
                    See under&nbsp;<a 
                        href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=263&amp;Itemid=27" 
                        target="_blank">Glycogen storage diseases</a>.</td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <ul>
                        <li>Tyrosinaemia type I</li>
                    </ul>
                </td>
                <td class="second">
                    <b>Amino acids - urine, organic acids</b> (succinylacetone).</td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Cholestasis (prolonged), especially&nbsp;</p>
                </td>
                <td class="second">
                    See
                    <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=124&amp;Itemid=27" 
                        target="_blank">Cholestasis</a></td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <ul>
                        <li>Primary biliary cirrhosis</li>
                    </ul>
                </td>
                <td class="second">
                    <b>Mitochondrial antibodies.</b></td>
            </tr>
            <tr>
                <td class="first">
                    <ul>
                        <li>Prolonged large duct obstruction</li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <ul>
                        <li>Biliary atresia</li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Drugs and toxins, including</p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <ul>
                        <li>Methotrexate</li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <ul>
                        <li>Aflatoxin</li>
                    </ul>
                </td>
                <td class="second">
                    In some geographic areas eg, Southeast Asia.</td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        Cryptogenic</p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=51&amp;Itemid=27" 
                            target="_blank">Anaemia</a></p>
                </td>
                <td class="second">
                    <p>
                        <b>FBC.</b> Anaemia is often multifactorial: likely cause(s) are indicated by 
                        the red cell indices and blood film findings.</p>
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <strong>Complications</strong></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=68&amp;Itemid=27" 
                            target="_blank">Ascites</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        Bleeding, due to:</p>
                </td>
                <td class="second">
                    See
                    <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=82&amp;Itemid=27" 
                        target="_blank">Bleeding disorders</a></td>
            </tr>
            <tr>
                <td class="first">
                    <ul>
                        <li>Failure of synthesis of coagulation factors, related to</li>
                    </ul>
                </td>
                <td class="second">
                    <b>PT, APTT</b>, fibrinogen. The APTT is less sensitive than the PT to the 
                    coagulation factor deficiency of liver disease.</td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <ul>
                        <li>
                            <ul>
                                <li><a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=583&amp;Itemid=27" 
                                        target="_blank">Vitamin K deficiency</a></li>
                            </ul>
                        </li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <ul>
                        <li>
                            <ul>
                                <li>Hepatocellular failure</li>
                            </ul>
                        </li>
                    </ul>
                </td>
                <td class="second">
                    See
                    <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=304&amp;Itemid=27" 
                        target="_blank">Hepatic failure</a></td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <ul>
                        <li><a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=739&amp;Itemid=27" 
                                target="_blank">Thrombocytopenia</a>,due to</li>
                    </ul>
                </td>
                <td class="second">
                    <b>FBC.</b></td>
            </tr>
            <tr>
                <td class="first">
                    <ul>
                        <li>
                            <ul>
                                <li>Alcohol marrow toxicity</li>
                            </ul>
                        </li>
                    </ul>
                </td>
                <td class="second">
                    See
                    <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=43&amp;Itemid=27" 
                        target="_blank">Alcoholism</a></td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <ul>
                        <li>
                            <ul>
                                <li><a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=186&amp;Itemid=27" 
                                        target="_blank">DIC</a> (usually low grade)</li>
                            </ul>
                        </li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <ul>
                        <li>
                            <ul>
                                <li><a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=345&amp;Itemid=27" 
                                        target="_blank">Hypersplenism</a></li>
                            </ul>
                        </li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <ul>
                        <li>Primary Fibrinolysis</li>
                    </ul>
                </td>
                <td class="second">
                    Usually low grade: <b>thrombin time, fibrinogen, euglobulin clot lysis time.</b> 
                    See
                    <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=231&amp;Itemid=27" 
                        target="_blank">Fibrinolysis</a></td>
            </tr>
            <tr>
                <td class="first">
                    <ul>
                        <li>Dysfibrinogenaemia</li>
                    </ul>
                </td>
                <td class="second">
                    <b>Thrombin time, reptilase time.</b></td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        Hepatic encephalopathy</p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=304&amp;Itemid=27" 
                            target="_blank">Hepatic failure</p>
                    </a>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=311&amp;Itemid=27" 
                            target="_blank">Hepatocellular carcinoma</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Hepato-renal syndrome</p>
                </td>
                <td class="second">
                    See&nbsp;<a 
                        href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=523&amp;Itemid=27" 
                        target="_blank">Renal failure</a>.</td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        Peritonitis</p>
                </td>
                <td class="second">
                    See under&nbsp;<a 
                        href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=43&amp;Itemid=27" 
                        target="_blank">Alcoholism</a>.</td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=346&amp;Itemid=27" 
                            target="_blank">Portal hypertension</a>, causing</p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <ul>
                        <li><a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=715&amp;Itemid=27" 
                                target="_blank">Splenomegaly</a></li>
                    </ul>
                </td>
                <td class="second">
                    May be associated
                    <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=345&amp;Itemid=27" 
                        target="_blank">Hypersplenism.</a></td>
            </tr>
            <tr class="last">
                <td class="first">
                    <ul>
                        <li>Variceal bleeding</li>
                    </ul>
                </td>
                <td class="second">
                    See&nbsp;<a 
                        href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=43&amp;Itemid=27" 
                        target="_blank">Alcoholism</a>.</td>
            </tr>
        </table>
    </div>
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            <h2>
                Glossary Terms</h2>
            <div>
                <h4>
                    ALT :</h4>
                <p>
                    Alanine aminotransferase</p>
                <h4>
                    ALP :</h4>
                <p>
                    Alkaline phosphatase</p>
                <h4>
                    APTT :</h4>
                <p>
                    Activated partial thromboplastin time</p>
                <h4>
                    AST :</h4>
                <p>
                    Aspartate aminotransferase</p>
                <h4>
                    DIC:</h4>
                <p>
                    Disseminated intravascular coagulation</p>
                <h4>
                    FBC :</h4>
                <p>
                    Full blood count , full blood examination, complete blood count</p>
                <h4>
                    GGT :</h4>
                <p>
                    Gamma glutamyl transferase (transpeptidase)</p>
                <h4>
                    IV :</h4>
                <p>
                    Intravenous</p>
                <h4>
                    K :</h4>
                <p>
                    Potassium</p>
                <h4>
                    LD :</h4>
                <p>
                    Lactate dehydrogenase</p>
                <h4>
                    PT :</h4>
                <p>
                    Prothrombin time</p>
            </div>
        </div>
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        <p id="thanks">
            The RCPA wishes to acknowledge the Australian Government Department of Health 
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